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Midwifery Research

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Susi Delaney

on 14 November 2016

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Transcript of Midwifery Research

?
the process of gaining knowledge via a planned strategy
Research:
Scientific - pure (basic), applied (biomedical), clinical
Humanities
Artistic
Marketing
Social
Economic, etc.
MANA Stats
Types of research:
How do we use research?
Can we apply findings to individuals?
Why evaluate research reports?
Assess validity
Assess applicability to your practice
Make findings available in a user-friendly format for parents
Resources for Research &
Understanding Research
MIDIRS
– Midwives’ Information & Resource Service; disseminates latest research info (journal and electronic)
Cochrane Library
Lamaze
research summaries – Lamaze/Health Professionals/Resources/Research Summaries (archive of past issues thru Oct ’08)
Science & Sensibility
- research blog about healthy pregnancy, birth, and beyond
Childbirth Connection
- evidence-based website aimed at consumers
Evidence-Based Birth
- blog that reviews research literature on topics relevant to birth practices
Cohort Study
non-experimental prospective study of a group of people who share a common experience (particular condition, exposure, or intervention)
studies outcomes over a long period of time
often (but not always) includes a control group
looks at additional risk, not cause
LIMITATIONS: time-consuming; cannot identify a cause-effect relationship
CONTRAST WITH: case control study
Crossover Trial
each participant receives both the control and the intervention in a random order, and paired comparisons are then made
all participants serve as their own controls
can include blinding
LIMITATIONS: cannot be used for interventions with a permanent or long-lasting effect; may require a resting interval between study periods
Ex. "Antihistamines vs. aspirin for itching in late pregnancy"
It explores relationships between facts
www.manastats.org
and
mana.org/dor//
Prospective, quantitative web-based data collection
Collects data from all types of midwives in all settings in North America
Only data collection for planned home births in the

U.S.
Data includes demographics, history, prenatal course, course of labor, postpartum, newborn, care management and outcomes
Entered by midwives or assistants
Available to researchers
Qualitative Research
Naturalistic paradigm; inductive reasoning
Examines human experiences, thoughts, feelings, behavior
Aims to give meaning to the human experience
Systematic
Data is in the form of words
Acknowledges subjectivity (individual interpretation)
Conducted in the natural setting (in context)
People gather data
Purposive sampling - conscious selection of subjects
Theory is emergent
Quantitative Research
Positivist paradigm; deductive
Uses facts, figures, numbers, experiments
Data is analyzed mathematically
Considered tangible and objective
Theory is pre-developed & tested
4 main types:
descriptive
- names and describes factors
correlational
- examines relationships between variables
quasi-experimental
- looks at causality
experimental
- tests interventions; strictly controlled (no context)
RCT
experimental study design:
random allocation of subjects
experimental group(s) and control group
manipulates a single independent variable
prospective design
best for studying effectiveness of an intervention
LIMITATIONS: can only study interventions; may have limited application to clinical practice; expensive; not always ethically feasible
Ex. A study of the effectiveness of misoprostol for PPH in a home delivery setting in rural Gambia vs. methergine
Case Study
(case report or case series)
simply describes a single case or several related cases
report rare events (unusual disease or presentation of disease, or unique management of disease)
trigger more detailed study - can serve as hypothesis for experimental study
LIMITATIONS: cannot look at cause and effect; lack a comparison group
Ex. "Placenta praevia, placental abruption and amphetamine use in pregnancy: a case study" - McLaurin & Geraghty (2012)
Grounded Theory
constant comparison - data is gathered and interpreted simultaneously
aims to describe and explain what is happening in a social setting
lit review conducted at the conclusion of the study
uses interviews, observation and document review
identifies core variables to direct the rest of the study
Ex. "An exploration of midwives' experiences and practice in relation to their assessment of maternal postnatal genital tract health" - Larkin (2013) - identified 3 sets of factors that enhance or inhibit midwives' clinical reasoning process
Ethnography
studies the culture of a group of people
uses observation
studies behavior and interactions
researcher often must become entrenched in the community being studies
used in healthcare to improve practice
Ex. "Being safe practitioners and safe mothers: a critical ethnography of continuity-of-care midwifery in Australia" - Dove & Muir-Cochrane (2014) - semi-structured interviews with midwives, their clients, and an OB, along with observation of continuity antenatals to explore the midwife-mother relationship and midwives' self-identity
Phenomenology
explores everyday life
includes observation of the participant and interaction of researcher and participant
common method: one-to-one interviews
"bracketing" - researcher suspends preconceived ideas; therefore, lit review is done after data collection
Ex. (1) "The experience of black fathers concerning support for their wives/partners during labour" - Sengane & Cur (2009) - interviewed 5 fathers who provided support and 5 fathers who did not provide support; identified positive attitudes to enhance and negative attitudes to counteract. (2) "Midwives lived experience of caring during childbirth" (Thelin, et al, 2014) - identified key characteristics in the answers 10 Swedish midwives provided to a single question
Why use research findings?
Experimental Research
3 elements:
Pre-post test design (measures outcome of interest)
Treatment & control groups
Randomized
The outcome of interest has already occurred
The frequency of a possible risk factor is compared between the study group & a similar control group
Looks at associations only
Case Control Study
http://mana.org/research/current-research-projects/waterbirth
Relative Risk (RR)
Odds Ratio
http://qsen-evidencebasedpractice.wikispaces.com/1+-+Home
Quasi-Experimental
lacks random assignment or control
Why evaluate research reports?
Image credit: https://en.wikipedia.org/wiki/File:ExplainingCaseControlSJW.jpg
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